What are some things you like or dislike?

Julie is a 4 y/o Hispanic female. Mother states Julie “missed her last immunizations and needs to catch up.” The Mother wonders when her daughter will stop wetting the bed. States she just recently started doing it. Keeps putting her hands “down there where she ought not to.” States she is starting to be very introverted. Cries when her mother is leaving for work. States her boyfriend is very attentive to her and keeps her on Tuesdays when she doesn’t have other childcare available. Mother thinks Julie must be nervous or something, so every-once-in-a-while she will give her some of her Xanax to help her relax. No significant PMH. No known drug allergies. Vital Signs WNL. BMI 30.  Impression/concerns As I read the details of Julie, I’m immediately suspecting she may have or continuing to be a victim of sexual abuse in the home. If Julie was not wetting the bed before and it just recently began, this is a classic red flag of sexual abuse (Mckinney 2022). She is also placing her hands “down there”. According to the American Academy of Pediatrics, sexual abuse can potentially cause long-term physical and psychological damage. Julie has predisposing factors of being a victim of sexual abuse. First, she is a minority child, adopted/stepchild, and lives in a single parent home. I wonder if the mother would be okay if I talked to Julie alone and if she refuses, this would be considered a “red flag”. I need to perform a history, physical examination (abnormal genital examination), and some lab tests. Julie may be at imminent risk of additional harm if sent back to the environment. Child protective services should be contacted because I must report suspected child abuse and neglect. I would inform the mother to stop giving Julie Xanax and question what other interventions she has attempted before giving Xanax? Evaluate the child’s overall appearance. Is the child clean and is her clothes appropriate for season, hygiene, depression, withdrawnness, behavioral compliance? I am also concerned about Julie’s weight after reflecting on her BMI of 30, which indicates her falling into the obese category (95th percentile or greater).  Questions for Julie: What are some things you like or dislike? How many people live at your home? Do you feel safe at home? Describe a typical day- what do you eat, who makes the food, where do you play, who comes/ leaves the house? Does any place on your body hurt? Are you afraid of anyone? Is anything bothering you? What happens when you take a bath? Do you have stomachaches, headaches, difficulty with bowel movements? Where do you sleep? What happens when you go to sleep? Has anyone touched you in a way you didn’t like? Have you ever tried to harm yourself? Do you eat breakfast in the morning?  Questions for Ginger: Does Julie have any allergies that you are aware of? Have you encourage your child to be independent? Does your child increasing independence create any exhibit or conflict for you? Is your child in preschool or daycare? How many hours or days? How does your child get along with other children that are the same age? How well does your child communicate with others? Do you have any concerns about your child speech? Has your child play become more imaginative? Does your child describe any fears? What activities do you enjoy together? Where did you obtain the Xanax? Do you have a prescription for Xanax? When was the last time you gave Julie a Xanax? Do you have anyone trustworthy to keep Julie while you’re at work? Do you need some assistance finding resources to aid in caring for Julie? Do you read to Julie? Do you practice counting numbers and singing ABCs? Does Julie conform two simple rules regarding behavior? Is Julie able to separate from you, after a short transition time, for at least half a day? Prepare your child for school. What ways have you been preparing Ginger for school?